Future doctors say they’re discouraged from working in states with abortion bans

(NEW YORK) — Lucy Brown, a medical student at Indiana University, wanted to stay in Indiana for her OB-GYN residency, but when Roe v. Wade was overturned last June, her priorities shifted. States with abortion bans in place fell to the bottom of Brown’s list.

“I really, really wanted to stay in the Midwest. I wanted to be close to my family, but it kind of conflicted with my No. 1 priority,” Brown told ABC News.

Brown will soon be moving to Baltimore for her residency — leaving behind her family and close friends for a city where she doesn’t know anyone.

An abortion ban in Indiana was put on hold by a judge as a lawsuit over its legality under the state’s constitution continues. But the looming case has created uncertainty around whether access to abortion care will remain in the state.

“There’s also a sense of dread that the injunction is just like a Band-Aid. And the ban is definitely going to go into effect,” Brown said.

Brown is unsure if she would come back to Indiana after completing her residency.

“I would find it very, very, very difficult to go back, as much as I want to. It would be really a tragedy for me to not be able to provide the full scope of reproductive care and have to go day by day and send people up to Chicago, or wherever, and not be able to do it myself,” Brown said. “My goal was to end up in Indiana, or at least around Indiana, but I don’t know if that’s going to be a safe or realistic option anymore.”

She is not alone.

Residency programs in states with bans in place saw a drop in the number of OB-GYN residency applications, according to recent data from the Association of American Medical Colleges. While there was an overall decrease in the number of all residency applications submitted in 2023, the decrease was sharper in states with complete bans compared to states without restrictions, according to the data.

There was a 10.5% decrease in OB-GYN applicants in states with complete bans in 2023 compared to 2022 residency applications. In states without restrictions, the decrease was only 5.3%, data shows.

Fifteen states have ceased nearly all abortion services since the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights.

Adriana Traub, a medical student at Emory University in Georgia, said the state’s so-called heartbeat ban “definitely impacted” where she plans on applying for residency in a year-and-a-half.

“Personally, I want to receive an education, if I go into OB-GYN, where I can learn how to provide abortion care services, and be able to also provide all options to my patients without being worried about losing my medical license — without being worried about having to tell a patient ‘no,'” Traub said.

Traub said the abortion bans have pushed her more toward specializing in OB-GYN.

“There is such a great need for it,” Traub said.

Marisa Giglio, a first-year resident at Rutgers University in New Jersey — whose family lives in North Carolina and Alabama — was very careful about where she applied, knowing the Supreme Court was hearing an abortion case. Months before Roe was overturned, she was in a “scramble” to find which states were planning to restrict abortion care and avoid them. But some of her classmates didn’t do the same.

“They ended up in states, now, that they won’t be able to train on these [skills] and they’re kind of scrambling to figure out ways that they can gain this training so that in the future they’ll be able to provide that care for their patients,” Giglio said.

Natalie Dicenzo, a third-year resident at Rutgers, is now applying for a complex family planning fellowship to provide complex contraception and abortion care. As she is applying, Dicenzo is prioritizing her safety and being able to provide that care, she told ABC News.

“I don’t envy the providers who already live in these states and are facing this on a daily basis,” Dicenzo said. “I’m not really itching to put myself in that position either. So I also would probably steer away from providing care in those states.”

There are 56 OB-GYN residency programs and over 1,100 residents in states with the most restrictive abortion bans in the country as of April 1, according to the Ryan Program, a subspecialty program that trains physicians on complex family planning — which includes complex contraceptive and abortion care — at Oregon Health & Science University.

Several residents from states with bans or restrictions in place who sought training at the Ryan Program are considering moving, Alyssa Colwill, the director of the program, told ABC News.

“A lot of them have seen patients, get unnecessarily sick, that have had hysterectomies, lost their fertility, because they’ve had pregnancy complications that could have been resolved with a safe and timely abortion, but instead had to wait until their life was at risk for intervention to happen,” Colwill said.

Abortion training and state legislation were among the top questions future residents had for programs in Ohio and Indiana where Dr. Katie McHugh works, she told ABC News. This is starkly different than what McHugh was prioritizing when she was in their shoes; she was worried about the quality of training and proximity to her family, she said.

“Now, [abortion laws] is all these medical students and residents are considering,” she said.

Dr. Beverly Gray, the director of Duke University’s residency program in North Carolina, told ABC News she has had more conversations with applicants about the political landscape in the last application cycle than ever before. But this is an issue that could stretch beyond just residents, she said.

“I have colleagues in Tennessee who have already left the state, who were providing family planning care and decided to leave the state. And so you have residents training there who may not have faculty with the expertise to train them; they’re having exposure to fewer clinical situations and procedures where they would get the training that they need to be competent,” Gray said.

“They may have less training and then they decide to stay in the state and then that’s this snowball effect that over time we have fewer and fewer people who have the requisite skills to provide second-trimester abortion care,” Gray said. “And there are certain emergencies that come up where we need that skill set to be able to intervene and save a life.”